I am happily coming down off the high of presenting at the Medical Students for Choice annual conference – I was part of a fantastic panel on Protecting Choice in Birth. I felt honored to be sharing the table with some brilliant people – two wonderful ob/gyns, two reproductive justice lawyers, and little old me. We talked about the legal and ethical underpinnings of patients’ rights and choice in birth: site of birth (e.g. out of hospital birth), VBAC, even use of a doula or refusal of certain interventions.

It was a wonderful experience. The director of MS4C told us the response was so overwhelming that the conference was buzzing about our panel, and we are definitely invited to return. I learned a lot from my co-panelists, and loved the enthusiastic response from the audience. One sweet medical student literally had his jaw agape when Farah Diaz-Tello, from the National Association for Pregnant Women, described a woman who had her baby taken away and put in foster care for simply wanting to postpone signing a blanket consent for any intervention or procedure during her labor and delivery. She had a healthy, spontaneous vaginal delivery with no complications during her SECOND psych consult (after the first psychiatrist deemed she was clearly mentally competent and allowed to refuse consenting to an unnecessary hypothetical cesarean), and apparently her six year old is still not in her care due to the red tape surrounding her case. Jaw dropping, indeed.

I talked about my journey, including being a patient, mother, midwifery student, doula and research fellow before becoming a doctor. I discussed the hostile-to-patient-autonomy atmosphere in South Florida, my fellowship research on labor interventions, and how to present risk to patients.

I almost burst into tears when my co-panelist, the lovely and dynamic Dr. Hanson, showed pictures of twins and breech births she has delivered all over the world. I did end up tearing up during lunch, not just because birth is moving and emotional, but because I am slowly accepting that I will most likely never be doing these difficult deliveries, and my wonderful copanelists innocently asked me about my residency plans. I may not be doing deliveries at all.

I got a decent amount of invitations to obstetrics residency programs. I am slowly canceling them, one by one. I simply cannot justify moving my two boys to a city where I don’t know anybody, then disappearing to work my ass off 80 hours a week at all times of day or night. I also don’t want to put them in public schools in the Deep South. When I got divorced during my third year of medical school I knew that would mean facing residency as a single mom. The divorce was worth it, but now that I have experienced the reality of how hard internship is, even with significant family support in my home town, I had to reconsider my options.

I will most likely be pursuing a family practice residency at a local residency program, probably at the hospital where I am doing my internship. Yes, obstetrics can fall under the family practice umbrella, but I would be the first family practitioner to get hospital privileges in the greater Miami area in recent or remote history. In other words, the chances of that happening falls between not likely and impossible. Yes, not even if I do an obstetrics fellowship, which would involve leaving town for a year. It’s just not the standard of care here, even if it’s normal in other parts of the country. And my custody arrangement stipulates that I practice here after training. So, even if I move for residency, I would have to uproot again and come back.

I can still do women’s health. I can still do prenatals. I can do lactation medicine, including the pediatrics portion. I can even be the medical director of a local freestanding birth center, just not their backup surgeon. Which, honestly, was never a huge draw for me. I want to be at the normal pregnancies, not a back up for the ones that go wrong. I can do family planning. I can still do academics, including medical ethics, which is an interest of mine.

So, most of the time I am ok with this. Most of the time. I have a lot to be happy about. I have great kids, good family support, a supportive director of my residency program, relatively good health, friends, a cute little house, a fuzzy loyal dog, and a blossoming (very tentative!) new relationship with a nice guy. And I’m a doctor, for Chrissakes. With a job in a shitty economy.

So, anyway, another permutation on the journey. Let’s see how it plays out.

8 responses to “Breaking the silence”

I’m a doula turned pre-med currently awaiting my interviews but since I have a family I’m already thinking ahead to residency & those sorts of logistics. Your exploration of your options is useful information and I appreciate you sharing your journey. I’m also pleased to hear that MS4C is receptive to discussion of choice as it relates to pregnancy & birth. For me, these are inextricably linked other reproductive health choices. I plan to join MS4C as a med student so I’m glad to hear that this conversation has already started.

Thanks for replying! At my first MS4C conference, access to home birth was mentioned in the keynote address. It is obviously not the focus of the organization, but I was so happy with the enthusiastic response at this conference.

The founder of MS4C, Dr. Jody Steinauer, stood in the back if the room (standing room only!) and offered a great story – an anecdote of a friend so fed up with the medical system tha she had a planned unattended birth, and how she had to advocate for her friend’s behalf when her immediate postpartum became complicated and she ended up in the hospital. She pointed out that if it wasn’t for her calling and saying this patient was a personal friend and to treat her well, who knows what would have happened, including a possible investigation. She emphasized that the take home message was that these mothers deserve our empathy, not our scorn or distrust, even if they make choices we don’t understand. Also, she implored the audience to question what would drive a woman to distrust the medic alizarin of birth so much that she would have an unattended birth.

Sounds like a fabulous conference, and oh so important given the current political climate in the States. I’m sorry to hear that things aren’t working out the way you had hoped with respect to residency. If it’s any consolation, a good friend of mine wanted to go into Obs-Gyne but opted to do Family Medicine at the last minute as she wanted a career that was more conducive to having a family. She’s managed to tailor her training to do primarily women’s health, and she’s ultimately happy that she made the decision she did. I hope that in the end you’ll be satisfied with the way that things turn out.

I think your decision probably makes sense. You would probably have to do a lot of medical interventions you didn’t agree with in ob/gyn residency. And isn’t there a lot of litigation against ob/gyns in that part of the country? Even if you do everything right you don’t know when some disgruntled patient might try to sue you because they think that their kid wouldn’t have been born with cerebral palsy if you had done a c-section right away (nevermind if it was medically necessary or not).

I’m sorry to hear that you won’t be able to pursue the residency you had planned on and dreamed of. It is sad that you won’t be able to do that, and for the patients you could have worked with; but I hope it is a net gain for you in other areas of your life, and for your patients, and for us! It sounds like you have worked out a lot of ways where you will be able to stay involved with pregnancy, birth, medical ethics, and all the other things you’ve been writing about so well for so long. I probably don’t need to tell you how awesome it is to have a family med doc doing lactation medicine… it knocks over a lot of barriers to have someone who can treat mom AND baby. (Will we start seeing you at Academy of Breastfeeding Medicine conferences?)

So, a permutation, and hopefully a good one. Please keep us all updated!